Quiz 1 Flashcards
(53 cards)
What drug may cause a modest transient increase in ICP?
succs
What do you want to ensure before laryngoscopy for a crani and why?
adequate depth of anesthesia and profound skeletal muscle paralysis to prevent noxious stimulation or movement that can increase BF, CBV, ICP
Why might you use propofol or barbiturates to induce a crani patient?
decreases CMR, CBF, CBV and ICP; can be used to induce isoelectric EEG
What may be a downside to using propofol or barbiturates for induction of a crani patient?
can cause hypotension (decreased perfusion)
When would you avoid using etomidate in a crani patient?
if you suspect cerebral vasospasm or other conditions associated with cerebral ischemia- also higher rate of PONV
What does etomidate do to CMR and ICP?
dose dependent decreases
What does ketamine do to CBF, CMR, and ICP?
increases all
Do opioids have a significant effect on cerebral physiologic parameters?
no, as long as MAP is maintained
If you use remi for induction for a crani, what should you also use?
infusion of remi to avoid abrupt offset and resultant HTN and tachycardia
Why might you use lidocaine for a crani patient?
suppress cough reflex during laryngoscopy and blunt hemodynamic response
Why might you avoid atracurium and mivacurium as your NDMRs for induction during a crani?
cause histamine release and may cause reduction in CPP from decreased MAP and increased ICP
How can you offset the transient rise in ICP while using succs?
give defasciculating dose of NDMR
In an adult, describe the distribution of the “rule of 9s”
anterior+posterior head: 9% anterior torso: 18% posterior torso: 18% each anterior leg: 9% each posterior leg: 9% anterior+posterior arm: 9% genitalia/perineum: 1%
In a child, describe the distribution of the “rule of 9s”
anterior head: 9% posterior head: 9% anterior torso: 18% posterior torso: 18% each anterior leg: 6.75% each posterior leg: 6.75% anterior+posterior arm: 9% genitalia/perineum: 1%
Identify the subdural vs epidural bleed
How much cardiac output does the brain receive?
15%
What is normal total CBF?
50 ml/100 g/min
CBF parallels ?
metabolic activity
What are the 5 determinants of CBF?
CMR, CPP, venous pressure, PaCO2, PaO2
What is the order of CSF flow?
choroid plexus -> lateral ventricles -> foramina of monroe -> 3rd ventricle -> aqueduct of sylvius -> fourth ventricle -> foramina of luschka and magendie -> subarachnoid space -> brain -> arachnoid villi
What is the Parkland formula?
fluid resuscitation for burns: 4 ml x weight in kg x % of burn give half over 8 hours and the second half over 16 hours
What kind of fluids should you avoid in the 1st 24 hours of thermal injury?
colloids
What is the detection window for alcohol?
2-12 hours
What is the detection window for benzos?
72 h
